Provider Demographics
NPI:1447896162
Name:REGIER, BROOKLYNN RENEE
Entity type:Individual
Prefix:MISS
First Name:BROOKLYNN
Middle Name:RENEE
Last Name:REGIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 LAGUNA MILL DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-4942
Mailing Address - Country:US
Mailing Address - Phone:813-922-6274
Mailing Address - Fax:813-922-6274
Practice Address - Street 1:9225 BAY PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4466
Practice Address - Country:US
Practice Address - Phone:813-440-4933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician